The World Health Organization (WHO) warned on Tuesday that infections of the Bundibugyo species of Ebola in the Democratic Republic of the Congo (DRC) have reached record highs, and a majority of new cases are coming from "unknown chains of transmission." Modeling by WHO indicates that the scale of the outbreak could be "at least two to four times" the number of reported cases.
After returning from Bunia in eastern DRC’s Ituri Province, which is at the heart of the outbreak, Chikwe Ihekweazu, Executive Director of WHO’s health emergencies program, told reporters in Geneva that the current outbreak is the third-largest ever, with close to 2,000 confirmed cases and more than 700 deaths across five provinces.
As of Sunday, national health authorities had reported 1,963 confirmed Ebola cases and 702 deaths in Ituri, North Kivu, South Kivu, Haut-Uele, and Tshopo provinces. “We've seen the fastest growth in a single month since the outbreak started and of all the Ebola outbreaks that we have managed,” he said.
“Over the last few days, we've seen some of the highest numbers of new infections in a single day,” Ihekweazu added, including over 80 cases confirmed in 24 hours.
Many of the newly reported deaths are of people who died in their communities without ever reaching a health facility or receiving care, which the WHO official described as "the most alarming finding."
Despite progress on diagnostics and high contact follow-up rates, Ihekweazu warned that “80 percent of new cases are outside our contact lists and are coming to us from unknown chains of transmission.”
The current outbreak was declared two months ago, and according to the latest modeling from WHO, its true scale could be at least two to four times larger than the number of reported cases.
“You have to imagine that this is a fire,” Ihekweazu said. “There's something driving the fire in its heart, and it's also expanding at the same time.”
Although up to 95 percent of all new Ebola cases emerge from Ituri Province, where the outbreak began, the virus has recently spread to two new provinces: Haut-Uele and Tshopo.
At least five provinces are now affected by the outbreak: Ituri, North Kivu, South Kivu, Tshopo, and Haut-Uele. According to the Congolese Ministry of Health, ten provinces are now considered high-risk, including Kinshasa.
In a related development, on Tuesday the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported that efforts to contain the outbreak are scaling up following the spread of Ebola to Haut-Uele and Tshopo, located hundreds of kilometers from the current epicenter.
OCHA stressed in an update that confirmation of cases in Kisangani — a city of over 1.6 million people and a major transport hub linking the east and west of the country — highlights the risk of wider transmission along key transport corridors, including the Congo River.
On Monday, UN Ebola Coordinator Julien Harneis returned from a mission to Kisangani with the Congolese Minister of Health, Incident Managers from the Africa Centers for Disease Control and Prevention, and WHO. The mission was intended to support provincial authorities in strengthening the response. National organizations, faith-based groups, and local community networks are already mobilizing on the ground.
On Monday, the International Rescue Committee (IRC) warned that the confirmation of two Ebola cases in Wamba, Haut-Uélé Province, near the border to South Sudan has significantly heightened the risk of cross-border transmission. The WHO estimates a 70 percent likelihood that Ebola will spread into South Sudan.
In Geneva, meanwhile, Ihekweazu outlined a two-pronged strategy for the overall response. First, continue pushing at the heart of the outbreak in Ituri. Second, "understand the travel routes [...] and really map out where the risks are of new cases coming up."
The WHO official urged the international community not to become despondent in the face of the disease's rapid spread and insisted that their work was yielding results.
“Now is not the time to drop the ball,” the WHO official warned.
Although some therapeutics are undergoing clinical trials, there is still no approved treatment for patients with the Bundibugyo strain of Ebola. Nevertheless, the chances of survival are significantly higher with early supportive care.
“We must find the cases earlier, bring them into care as soon as possible” to reduce transmission in the community and avoid staying behind the curve,” Ihekweazu said.
When asked about recent attacks on healthcare workers and facilities, he explained that the solution lies in "being open and transparent" about the care being provided.
“Before any new center is opened, we invite leaders of the community to see what is being done” and to speak with the health care providers who have left their homes to support the response, he said.
Preventing attacks on healthcare workers and facilities relies on building community confidence in the new centers by showing people that “they're not going to be left alone - they'll not only be treated, they'll be offered food, they'll have access to their families”.
As the struggle to stop the spread of Ebola in DR Congo continues, Ihekweazu spoke of “dissonance between the threats facing us and the efforts that we're making to respond.”
“We need the world to come together, not just out of charity or out of support for the DRC, but in our own enlightened best interest. The more we do right now, the better placed we will be in the future,” he said.
Meanwhile, aid agencies on the ground in DRC are expanding surveillance, laboratory capacity, case management and community engagement efforts to contain the outbreak. The response has made important gains in recent weeks, with 85 percent of alerts now being investigated, and 80 percent of identified contacts being traced and monitored, OCHA reported.
Eleven decentralized laboratories are now operational, raising testing capacity to up to 250 samples per day, according to the humanitarian office. At the same time, treatment capacity has expanded to 22 Ebola Treatment Centers and seven transit centers, providing more than 700 beds across affected areas.